Neonatal multidrug-resistant bacterial meningitis: a 29-year study from a tertiary hospital in Thailand.

Anucha Thatrimontrichai,Gunlawadee Maneenil,Supaporn Dissaneevate,Waricha Janjindamai

doi:10.3855/jidc.12808

Anucha Thatrimontrichai, Gunlawadee Maneenil + Show 2 more

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https://doi.org/10.3855/jidc.12808

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Abstract

This study aimed to compare the risks and case fatality rate (CFR) between neonatal multidrug-resistant (MDR) and non-MDR meningitis. a secondary analysis of a case-control studies in a Thai neonatal intensive care unit between 1990 and 2018 was performed. The pathogenic organisms causing neonatal meningitis were Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae, Acinetobacter spp., and Pseudomonas aeruginosa. A MDR organism was defined as an isolate that was non-susceptible to at least 1 agent in at least 3 antimicrobial categories. The multivariate regression was analyzed for MDR and non-MDR samples of neonatal meningitis. Over a period of 29 years, the number of neonatal MDR and non-MDR meningitis cases were 17 and 21, respectively. The medians (interquartile ranges) of gestational age, birthweight and onset of meningitis were 35 (29.5-38) weeks, 1,945 (1,218-2,859) grams and 6.5 (2.8-17.9) days, respectively. The most common organism was Acinetobacter baumannii (32%). By multivariate analysis, neonates who had MDR meningitis were more likely to have a lower Apgar score at 5 minutes (adjusted odds ratio: 95% confidence intervals = 0.66 [0.44-0.99], p = 0.04). The crude CFR of neonatal meningitis was 32%. Non-survivors in MDR meningitis (58.8%) were significantly higher than non-MDR meningitis (9.5%, p = 0.004). The most common pathogen in non-survivors was carbapenem-resistant Acinetobacter baumannii. Neonatal MDR meningitis has an association with lower APGAR scores, and higher CFR as well as Acinetobacter baumannii. Multifaceted infection prevention, and control programs for MDR organisms are crucial, and must be strictly implemented in high MDR areas.

Highlights

This study aimed to compare the risks and case fatality rate (CFR) between neonatal multidrug-resistant (MDR) and non-MDR meningitis
Neonates who had MDR meningitis were more likely to have a lower APGAR score at 5 minutes; whereas, history of either the third generation of cephalosporin or aminoglycoside use was not statistically significantly different
The major pathogens of neonatal meningitis are group B Streptococcus (GBS), E. coli and Listeria monocytogenes [17], whereas southeast Asia has the lowest amount of neonatal GBS diseases in the world [18,19], and neonatal listeriosis is uncommon [20]

Summary

Introduction

This study aimed to compare the risks and case fatality rate (CFR) between neonatal multidrug-resistant (MDR) and non-MDR meningitis. Conclusions: Neonatal MDR meningitis has an association with lower APGAR scores, and higher CFR as well as Acinetobacter baumannii. The incidence of neonatal meningitis in developing countries or resource-limited settings ranges was from 0.2 to 6.1 (Turkey 0.22, Costa Rica 0.25–2.66, Thailand 0.37, Africa and South Asia 0.81– 6.1, Kuwait 2.4, Nigeria 4.7) cases per 1,000 live births, with a mortality rate between 40% and 58% [3,7,8,9,10]. Neonatal multidrug-resistant (MDR) sepsis and meningitis are a serious threat because of their high mortality and morbidity [8,10,12,13]. There is limited research on neonatal MDR meningitis or carbapenem-resistant Acinetobacter baumannii (CRAB) pathogens

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